Demonstration environment. Fictional organization, fictional payers, synthetic data throughout. No patient data. Changes you make stay in this browser only.
ParvinCorpPayer Remittance Bridge

Ridgeline Health Partners. Multi-specialty physician group, 6 sites, 14 providers. This demo covers 12 billing providers, 4 billing locations and 4 contracted payers.

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Dana Whitfield, Billing Operations Lead. Imports remittance files, works denials and underpayments, and is the only role that can open a raw remittance file from a payer (835).

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OverviewThe numbers that matterWork queue (102)What to fix, by deadlineDenialsWhy money did not arriveAwaiting paymentBilled, no answer yetImport a fileCheck and load a payer's payment fileClaimsEvery claim and its resultRemittancesPayments receivedPayersContracts and performanceReason codesPlain language lookupOrganizationEntities, regions and sitesGuided tourFive minute walkthrough
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Denials

Why payers refused money, grouped the way a practice fixes it. Each reason is the largest refusal on the claim; the claim page lists every code.

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Payments dated Aug 4, 2026 to Sep 29, 2026, as of Oct 7, 2026. Whole organization, every site.

Filtered to: site Main Campus, Eastgate Family Care or Stonebridge.

Every regionEast RegionWest Region
Every siteMain CampusJefferson ParkEastgate Family CareStonebridgeRiverbendRiverside Orthopedics
Denial rate
9.6%
32 of 333 claims, fully or partly
Refused
$5,084.18
Valued at the contract rate
Preventable before the visit
31.3%
$2,212.20: eligibility, authorization, payer order, enrollment
Codes in play
11
Distinct primary reasons

By kind of problem

  • Prior authorization Front end5 · $1,326.00
  • Medical necessity 6 · $1,099.40
  • Coding error 7 · $819.50
  • Eligibility Front end2 · $436.60
  • Missing or invalid information 4 · $428.18
  • Provider not eligible Front end2 · $317.00
  • Filed too late 1 · $153.40
  • Duplicate 1 · $153.40
  • Another payer is responsible Front end1 · $132.60
  • Not covered by the plan 1 · $118.00
  • Bundled into another service 1 · $84.50

By payer

PayerDeniedRateRefused
Fernhollow Community Care8 of 6412.5%$1,016.34
Granite Plains Mutual14 of 11112.6%$2,711.64
Silver Mesa Senior Advantage6 of 767.9%$766.00
Tallow Creek Health Plan4 of 824.9%$590.20

By provider

Which clinician's claims are refused, largest refusal first. A pattern here usually points at documentation, coding habits, or an enrollment gap.

ProviderDeniedRateRefused
Dr. Alana Reyes7 of 5213.5%$676.24
Dr. Samuel Ivers4 of 517.8%$343.14
Dr. Grace Lindqvist4 of 468.7%$539.70
Jordan Blake, PA-C4 of 3810.5%$826.60
Dr. Victor Adeyemi1 of 342.9%$306.80
Dr. Owen Whitaker2 of 326.3%$509.60
Dr. Nina Castellano5 of 2817.9%$950.40
Dr. Martin Osei4 of 2814.3%$672.10
Dr. Tomas Varga1 of 234.3%$259.60
Maya Chen, NP0 of 10.0%$0.00

By location

Which site's claims are refused. A pattern here usually points at the front desk: eligibility checks, authorizations, or the wrong payer on file. Each location opens its site's claims.

LocationDeniedRateRefused
Stonebridge9 of 7112.7%$1,748.60
Eastgate Family Care9 of 1098.3%$1,732.90
Main Campus14 of 1539.2%$1,602.68

Every reason, with the usual fix

Payer reason codeWhat it meansUsual fixClaimsAt stake
197
Prior authorization missing
Authorization or notification was required and not on file.If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient.5$1,326.00
50
Not medically necessary
The payer decided the service was not medically necessary.Appeal with the visit note and any supporting records.6$1,099.40
4
Modifier does not fit the code
The procedure code does not agree with the modifier billed, or a required modifier is missing.Fix the modifier and send a corrected claim.7$819.50
27
After coverage ended
The service date is after the patient coverage ended.Verify eligibility for the service date and bill the plan that covered it. The patient can be billed only when the payer sends it as patient responsibility (group PR).2$436.60
16
Missing or invalid information
The claim is missing information or has a billing error. A remark code usually says which field.Read the remark code, fix the field it names, and resubmit.4$428.18
185
Rendering provider not eligible
The rendering provider is not eligible to perform the service billed.Check the provider enrollment with this payer. A credentialing gap is the usual cause.2$317.00
29
Filing deadline passed
The claim reached the payer after its timely filing limit.Appeal only with proof of timely submission; otherwise write it off. It cannot be billed to the patient.1$153.40
18
Exact duplicate
The payer already received this exact claim or service.Confirm the original claim was paid. If it was, no action is needed.1$153.40
22
Another payer may be primary
Coordination of benefits: the payer believes another plan should pay first.Update coverage order with the patient and bill the primary plan.1$132.60
96
Non-covered charge
The service is not covered. A remark code usually says why.Bill the patient only if they signed a waiver or the plan allows it; otherwise write off.1$118.00
97
Bundled into another service
Payment for this service is included in another service on the same day.If the service was separate and distinct, add the right modifier and send a corrected claim.1$84.50

Scroll sideways to see every column.